Renal Function and Oral Anticoagulant Treatment of Incident non-valvular Atrial Fibrillation: A Retrospective Study

Ramagopalan, Sreeram; Stamp, Elaine; Sammon, Cormac; Besford, Megan; Carroll, Robert; Mehmud, Faisal; Alikhan, Raza

doi:10.2217/fca-2019-0012

Cited by 8 publications

(7 citation statements)

References 35 publications

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“…Consistent with other studies, the use of the dabigatran 150 and 110 mg twice daily doses in patients with a CrCl <30 mL/min was less than 1%, indicating that contraindicated dabigatran use is rare in clinical practice. 24,25 For other NOACs, similar prescription rates were observed across CrCl groups, which is probably related to label differences (i.e., <15 mL/min for rivaroxaban, edoxaban, and apixaban in the European Union, and no contraindications for rivaroxaban and apixaban in the United States). Moreover, the enrollment period must be taken into account.…”

Section: Discussionmentioning

confidence: 69%

Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF

Wall

Teutsch

Dubner³

et al. 2021

TH Open

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Objective Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users. Methods Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international, prospective, and observational study program involving patients with newly diagnosed AF at risk for stroke. Prescription patterns were assessed by creatinine clearance (CrCl) at enrollment. Dabigatran users were followed for 2 years. Clinical outcomes were standardized for stroke and bleeding risk, based on CHA2DS2-VASc and HAS-BLED scores, with missing values imputed. Results Baseline CrCl values were available for 12,056 of 15,308 eligible patients (79%). With declining renal function, prescriptions increased for vitamin K antagonists (VKAs) and decreased for dabigatran (30–47% and 34–12%, respectively). The prescription of other non-vitamin K antagonists remained similar across CrCl groups (14–19%). In 4,873 dabigatran users, standardized stroke rates were low across all CrCl groups; 0.58/100 patient-years (95% confidence interval [CI]: 0.30–0.90) in CrCl ≥80 mL/min, 0.85 (95% CI: 0.48–1.21) in CrCl 50 to 79 mL/min, and 0.33 (95% CI: 0.06–1.11) in CrCl 30 to 49 mL/min. Similarly, major bleeding rates were low and numerically increased with declining renal function (0.68/100 patient-years, 95% CI: 0.39–1.03; 0.92, 95% CI: 0.58–1.32; and 1.26, 95% CI: 0.66–1.97, respectively). Conclusion In patients with AF, VKA prescriptions increased and dabigatran prescriptions decreased with declining renal function. Rates of stroke and major bleeding in dabigatran patients remained low across the categories of renal impairment.

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Section: Discussionmentioning

confidence: 69%

Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF

Wall

Teutsch

Dubner³

et al. 2021

TH Open

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“…В аналогичном исследовании S. V. Ramagopalan и соавт. [29] в период с 2013 по 2017 г. из 18 419 пациентов с впервые выявленной ФП выделили группу больных с ФП и СКФ <30 мл / мин / 1,73 м 2 (n=1857). ППОАК рекомендованы 13 % больных с ХБП IV стадии, 14 % -с ХБП V стадии, в половине случаев антикоагулянтная терапия не назначалась, большинство больных принимали варфарин (30 и 37 % при ХБП IV стадии и V стадии соответственно).…”

Section: пациентовunclassified

Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments

et al. 2020

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Objective. To estimate the prevalence of chronic kidney disease (CKD) 3b – 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy.Materials and Methods. Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b – 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected.Results. Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 – warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 – apixaban 10 mg / day (16.2 %).Conclusion. A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % – warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.

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“…The presence of AF is known to increase the risk of chronic kidney disease (CKD) by two-thirds 3 . On the contrary, the prevalence of CKD in patients with comorbid atrial fibrillation is up to three times more common than in the general population 4–6 …”

Section: Introductionmentioning

confidence: 99%

Renal function and mortality in patients with atrial fibrillation

Liampas

Κάρτας

Samaras

et al. 2022

Journal of Cardiovascular Medicine

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AimThe aim of this study is to examine the association of the presence of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) values with mortality in patients with atrial fibrillation.MethodsThis posthoc analysis of a randomized controlled trial consisted of hospitalized patients with atrial fibrillation who were followed up for a median of 2.7 years after discharge. Kaplan–Meier curves, multivariate Cox-regression and spline curves were utilized to assess the association of CKD, CKD stages 2–5 according to the KDOQI guidelines, and the continuum of eGFR values with the primary outcome of all-cause death, and the secondary outcome of cardiovascular mortality.ResultsOut of 1064 hospitalized patients with atrial fibrillation, 465 (43.7%) had comorbid CKD. The presence of CKD was associated with an increased risk for both all-cause and cardiovascular mortality following hospitalization [adjusted hazard ratio (aHR): 1.60; 95% confidence intervals (95% CIs): 1.25–2.05 and aHR: 1.74; 95% CI: 1.30–2.33, respectively]. The aHRs for all-cause mortality in CKD stages 2–5, as compared with CKD stage 1 were 2.18, 2.62, 4.20 and 3.38, respectively (all P < 0.05). In spline curve analyses, eGFR values lower than 50 ml/min/1.73 m2 were independent predictors of higher all-cause and cardiovascular mortality.ConclusionIn recently hospitalized patients with atrial fibrillation, the presence of CKD was independently associated with decreased survival, which was significant across CKD stages 2–5, as compared with CKD stage 1. Values of eGFR lower than 50 ml/min/1.73 m2 were incrementally associated with worse prognosis.

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Renal Function and Oral Anticoagulant Treatment of Incident non-valvular Atrial Fibrillation: A Retrospective Study

Cited by 8 publications

References 35 publications

Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF

Anticoagulation Prescription and Outcomes in Relation to Renal Function in Patients with Atrial Fibrillation: Results from GLORIA-AF

Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments

Renal function and mortality in patients with atrial fibrillation

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